Provider Demographics
NPI:1447904792
Name:KWIECINSKI, ANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:KWIECINSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 S INDUSTRIAL HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6796
Mailing Address - Country:US
Mailing Address - Phone:734-971-8286
Mailing Address - Fax:734-232-2277
Practice Address - Street 1:2850 S INDUSTRIAL HWY STE 200
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6796
Practice Address - Country:US
Practice Address - Phone:734-971-8286
Practice Address - Fax:734-232-2277
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502006200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant